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Neuroleptic medications, which block dopamine receptors, are effective antipsychotic agents. They have, however, been fraught with adverse effects, particularly extrapyramidal syndromes (EPS). The new generation of antipsychotics are referred to as “atypical” antipsychotics because their antipsychotic actions are rarely associated with acute or subacute EPS in psychiatric populations.1
Psychosis occurs in approximately 20% of patients with PD who are treated with antiparkinsonian agents, and is the number one cause of nursing home placement.2 Patients with PD are, however, extremely sensitive to antidopaminergic actions of drugs. Until fairly recently, clinicians attempting to treat drug-induced psychosis in PD were in a quandary. Potential treatment strategies were limited to the equally unsatisfactory options of reducing the antiparkinsonian medications or using a neuroleptic, both of which generally worsened motor function.
Recently, the “atypical” antipsychotic clozapine …
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